Clinical Medications Worksheets

Generic Name Trade Name Classification Dose Route Time/frequency

simvastatin Zocor HMG-CoA reductase inhibitors 40 mg PO Qd
lipid-lowering agents
Peak Onset Duration Normal dosage range
unknown unknown unknown 5mg/day initially. Increase at 4-week intervals up to 40mg/day
Why is your patient getting this medication For IV meds, compatibility with IV drips and/or solutions
Hyperlipidemia N/A
Mechanism of action and indications Nursing Implications (what to focus on)
(Why med ordered) Contraindications/warnings/interactions
Inhibit an enzyme, 3-hydroxy-3-methylglutaryl- coenzyme Hypersensitivity, cross-sensitivity among agents may occur, sepsis,
A (HMG-CoA) reductase, which is responsible for acute hypotension, history of liver disease or significant alcohol
catalyzing an early step in the synthesis of cholesterol. use/abuse, visual disturbances.
Common side effects
Abdominal cramps, constipation, diarrhea, flatus, heartburn, rashes,
rhabdmyolysis (rapid breakdown of skeletal muscle tissue)
Interactions with other patient drugs, OTC or herbal Lab value alterations caused by medicine
medicines (ask patient specifically) Evaluate serum cholesterol and triglyceride levels before
Protonix: A case report suggests that coadministration with initiating,
u after 4-6 wk of therapy, and periodically thereafter.
esomeprazole may increase the plasma concentrations of s
atorvastatin and the associated risk of myopathy. The e
proposed mechanism is competitive inhibition of intestinal P-
glycoprotein, resulting in decreased drug secretion into the t
intestinal lumen and increased drug bioavailability. Another, h
perhaps minor mechanism is competitive inhibition of y
CYP450 3A4 metabolism. r
Synthroid: Rarely, lovastatin and simvastatin have been o
reported to reduce the pharmacologic effects of thyroid i
hormone. The exact mechanism of interaction is unknown. In d
isolated case reports, patients stabilized on levothyroxine
developed symptoms of hypothyroidism and/or elevated f
thyroid-stimulating hormone (TSH) levels following the u
addition of lovastatin or simvastatin. Discontinuation of the n
statin led to resolution of symptoms and normalization of c
TSH levels. In one case, the patient was subsequently t
prescribed pravastatin without any adverse effects on his i
thyroid status. No particular intervention should be necessary o
when lovastatin or simvastatin is prescribed to patients n
receiving thyroid hormone therapy, since the interaction
appears to be extremely rare. However, thyroid hormone t
dosage may need to be adjusted if an interaction is suspected. e
Alternatively, a switch to a statin with a different metabolic s
profile such as fluvastatin, pravastatin, or rosuvastatin may t
help. a
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Be sure to teach the patient the following about this medication

Instruct patient to take medication as directed and not to skip doses or
double up on missed doses. Advise patient to avoid drinking more that
1 qt/day of grapefruit juice during therapy. Medication helps control
but does not cure elevated serum cholesterol levels. Advise patient that
this medication should be used in conjunction with diet restrictions
(fat, cholesterol, carbohydrates, alcohol), exercise, and cessation of
smoking. Instruct patient to notify health care professional if
unexplained
muscle pain, tenderness, or weakness occurs, especially if
accompanied by fever or malaise. Advise patient to wear sunscreen
and protective clothing to prevent photosensitivity reactions (rare).
Emphasize the importance of follow-up exams to determine
Nursing Process- Assessment
(Pre-administration assessment)
Obtain a dietary history, especially with regard to
fat consumption, ophthalmic exams are
recommended before and yearly during therapy.
Assessment
Why would you hold or not give this med?
If patient develops muscle tenderness during
therapy, monitor CPK levels. If CPK levels
are markedly ↑ or myopathy occurs, therapy
should be discontinued.
Evaluation
Check after giving
Decrease in serum LDL, VLDL,
and total cholesterol levels.
Increase in HDL cholesterol
levels. Decrease in triglyceride
levels.